These books provide more information:
Safe use of Medications by Older People. National Institutes of Health, National
Institute on Aging. Bethesda, MD: U.S. Department of Health
and Human Services, 2000
Recommendations and Safety Tips
Consumer Reports Books and the U.S. Pharmacopeial Convention. Complete Drug
Reference. Mount Vernon, NY: December 2002.
The People’s Pharmacy Guide to Home and Herbal Remedies,
Joe S. Greadon and Teresa Greadon.New York: St. Martin’s Press, Inc., 2002.
The Pill Book, Harold M. Silverman. New York: Bantam Books, Inc., 2002.
Waltz, Mitzi, editor. Webster’s New World Medical Dictionary.
New York: IDG Books Worldwide, February 2000.
Web sites:
Health Finder: www.heatlhfinder.gov
Food & Drug Administration, Center for Drug Evaluation & Research:
www.fda.gov/cder
Getting Well Network: www.pdr.net
National Council on Patient Information and Education:
www.talkaboutrx.org
HOW TO PREVENT
MEDICATION ERRORS
National Library of Medicine: www.nlm.nih.gov
Institute for Safe
Medication Practices
1800 Byberry Road, Suite 810
Huntingdon Valley, PA 19006
Tel: 215/947-7797
www.ismp.org
Sponsored through an unrestricted educational grant from Medco Health Solutions, Inc.
© 2004 Institute for Safe Medication Practices
Institute for Safe
Medication Practices
RECOMMENDATIONS AND SAFETY TIPS–
HOW TO PREVENT MEDICATION ERRORS
U
Unfortunately, medication errors occasionally occur. These errors can
happen when you are a patient in the hospital, when you get prescriptions
filled at your local pharmacy, mail order pharmacy, on-line pharmacy, or
even when you take your medicines in your own home. This may seem
scary, but luckily even when a mistake does occur there are usually no
serious effects. Yet sadly, every once in a while these mistakes can hurt you
or a family member. For this reason, it is very important that you take an
active role in your own care by learning about your medicines.
Just like when you fly in an airplane, it is in your best interest to read the
emergency information sheet, listen to the flight attendant, buckle your
seat belt, and know where the nearest exit is. It is also in your best interest
to know about your medications, learn how and when to take them,
what the effects and side effects are. The best place to get this information
is from your doctor, pharmacist, or nurse. If you would like more
information you can visit web sites, a bookstore or library. But, you have
to be very careful when reading about your medications because not all
the information that you find may be accurate. On the back page of this
pamphlet there is a list of some reliable web sites and books to learn more
about your medicines.
Your doctors, nurses, and pharmacists work very hard to give you safe
care and to prevent mistakes. But, you can also help to prevent mistakes.
This pamphlet tells you why some medication errors occur, even when
steps are in place to stop these errors. In addition, it will provide you with
some safety tips on how to prevent these errors from happening to you and
your family.
2
WHILE YOU ARE IN THE HOSPITAL…
PROBLEM
PROBLEM
PROBLEM
PROBLEM
A mistake can happen to you if the hospital
staff doesn’t have all the information they
need to make the right medication
decisions. For example, you may feel
uncomfortable telling the doctor that you
are using over-the-counter medicines or an
“alternative” drug therapy such as herbal
remedies or nutritional supplements. If you
do not tell them about all your medicines,
you could be putting yourself at risk for a
serious drug/herbal interaction or a false
blood test result.
You could receive the wrong medicine if
you are not wearing a patient identification
or barcode bracelet or if someone gives you
medicine without first checking your
bracelet.
Although rare, it’s possible that you could
receive the wrong medicine when a new
medicine is ordered for you. This can hap pen when the doctor writes the order for
the drug, when the pharmacy fills the order,
or when the nurse gives the medication.
When you are in the hospital you are often
started on new medications and occasionally
your doctor will change the dose of a drug
that you had been taking. Occasionally,
mistakes can happen when you are ready to
go home because your drug list was not
updated before leaving the hospital.
RECOMMENDATION
Always keep an up-to-date complete drug
list. This list should have all of the current
medicines you are taking. Also mark down
any drugs that you are allergic to and
describe what happens to you when you
take that medicine. Include drugs that are
ordered by your doctors, over-the-counter
medicines, vitamins, nutritional supplements, and herbal products. Take all of your
prescription medications and other drugs to
the hospital with you so that the doctor or
nurse can look them over to identity them
and then send them home with your family.
TIP
To start your drug history, have your pharmacist(s)
give you a printout from the computer, which lists
all of the drugs that you are now taking. Make
copies of your drug histor y. Keep one with you in
your wallet and give one to a family member.
Remember to keep the list up-to-date.
3
RECOMMENDATION
Do not let anyone give you medicines without checking your patient identification or
barcode bracelet first. Hold out your wrist
so that they can read your name or scan a
barcode. Look at all of your medicines
before you take them. If a medication
doesn’t look like what you usually take,
ask why before you take it. It might be a
generic drug (which is okay), or it might
be the wrong drug.
RECOMMENDATION
Tell your doctor and nurse you want to
know the name of any new medicine that is
ordered and what it’s being used for, so that
you can make sure that it is the right medicine for you. If you are not sure that the
medicine is really for you, don’t take the
medicine until you get an answer that
makes sense to you.
TIP
TIP
Ask your nurse to give you a list of the drugs that
you are taking while you are in the hospital (with
the generic and brand names for each) and what
times you should expect the medicines. Ask your
nurse to keep your drugs in their original package
and to open them at your bedside right before
giving them to you. If anything seems wrong, or
if you think a dose was missed, ask the nurse to
check it out before you take the drug.
When a new medicine is ordered and you are not
familiar with it, ask your nurse for some written
information about the drug.
PROBLEM
Sometimes a drug is given to you before
your healthcare providers know if you have
any drug, dye, or food allergies. A mistake
can happen if you get a drug or dye that
you have an allergy to or take a drug that
has a food product that you are allergic to.
RECOMMENDATION
Whenever a new medicine is ordered or you
get a new medication, remind your doctor
and nurse that you have an allergy. It is also
important to ask if you will need any dyes
or special medications before a test or procedure is performed.
RECOMMENDATION
Make sure that when you are ready to leave
the hospital that the doctor, pharmacist, or
nurse goes over each medication (name of
drug, dose, when to take it, etc.) with you
and/or a family member. When you get
home remember to update and make any
changes in your medication list. Know the
brand and generic names so you don’t take
duplicates medications.
TIP
While you are in the hospital you can always ask
to talk with a pharmacist about the new drugs you
are taking. Also, get the name of your doctor and
his/her phone number so that if there is a problem
with your medications, you and/or your pharmacist
can contact him/her to clarify the correct medications
you should be taking.
TIP
Ask your nurse to make sure your allergy is listed on
the chart and that the pharmacy has also entered
this information into their computer. Consider buying a MedAlert bracelet if you have a severe allergy
to drugs or foods such as penicillin or shellfish.
4
AT THE DOCTOR’S OFFICE…
PROBLEM
Getting drug samples is a good way to see
how a drug will work for you before you get
a prescription filled. However, they can
cause problems. Sometimes mistakes can
happen if your allergies are not checked or
if the sample drug has any interactions with
your other prescription medicines, over-thecounter drugs, herbals, etc., that you are
taking. For example, aspirin is a common
allergy and people with this allergy cannot
take non-steroidal anti-inflammatory
medicines such as Motrin and Toradol.
RECOMMENDATION
If you have any allergies, remind your
doctor about them before taking samples.
Ask him/her to check the sample medicine
against the medicines you are taking to
make sure there are no bad interactions.
Even though the sample medicine will have
some information on the package, ask the
doctor to explain the reason for the medication, how to take the medicine, including
any mixing instructions, what side effects
to look for or anything special you should
know about the drug.
TIP
If your doctor does not check the sample medicine
with a drug information book or special computer,
you might want to ask your pharmacist to check out
the drug for you. He/she can make sure that there
are no problems with allergies or side effects before
you start the medicine. Also, check the expiration
date on the package, as samples may be stored for a
long period of time in a doctor’s office before use.
5
PROBLEM
Your doctor hands you a prescription and
tells you to have it filled. He/she doesn’t tell
you the name of the drug, how to take it or
what types of side effects you may experience. Sometimes doctors do not provide
enough information on the drugs they
prescribe, leaving you in the dark as to what
to expect.
IN YOUR HOME…
PROBLEM
Mistakes can occur when people have trou ble swallowing a tablet or capsule and they
try to chew, crush, break or mix the tablet
or capsule in food or drink. This can cause
a bad effect because some are long-acting
medicines that will be released too fast.
Other medicines either will not work
properly or could even make you sick.
RECOMMENDATION
RECOMMENDATION
Prescribers can help you learn more about
your drugs by offering you patient information sheets. These patient education tools
provide information on the name of the
drug, why it’s prescribed and the most
common side effects you might experience.
If you have trouble swallowing medicines,
ask your doctor or pharmacist if the drug
comes in a liquid. Never che w, crush, break
or mix the tablet or capsule in fluid unless
your doctor or pharmacist says it is all right
to do so.
TIP
TIP
Always ask your prescriber to not only tell you the
name of the drug he/she prescribes for you, but to
include other important information such as why
it’s taken and possible side effects. A printed information sheet is a good source of information but the
pharmacist is the best source of information on how
to safely use prescription and nonprescription drugs.
Some medications are long acting or have a special
release mechanism that can be altered or destroyed
when you change the drug in any way. As a general rule, if the drug’s name is followed by the letters
“LA” (long acting), “CR” (controlled released),
“SR” (sustained release), etc., or the drug is to be
taken every 12 hours or once a day, you have to
swallow the tablet or capsule whole for it to work
right. This rule is also true for o ver-the-counter
medicines that are long acting. Take your medications with water rather than other liquids because
these might change how your drug works.
PROBLEM
You can have a bad effect if you take certain
medicines that are old (past the expiration
date). While most medications will only
lose their strength, some outdated medicines
can actually become toxic and make you
sick.
RECOMMENDATION
Do not save old medicines. Check your
medicines (prescription and over-the-counter) every 6 months for their expiration date
and get rid of all drugs that are out of date.
If you have any questions about outdated
medications, call your pharmacist before
you take it.
TIP
Flush any old medicine you have been saving,
including used patches (cut up), down the toilet
and not in the trash or wastebasket. This is important because children and pets have been known to
find the medicine and even eat them.
PROBLEM
If you have a long-term condition (heart
condition, diabetes, etc.), you may have to
take many different kinds of medications.
Sometimes, you may also have medications
ordered by different doctors. This can lead
to mix-ups and medication mistakes may
occur when you have many prescriptions.
RECOMMENDATION
As a safety measure, ask to schedule a
“brown bag check-up” with your prescribing
doctor or pharmacist. A brown bag
check–up is when you gather all of your
current medications and over- the-counter
products (including herbal products or
“natural products”) into a brown bag and
show them to your doctor or pharmacist so
he/she can look for any potential problems.
TIP
Schedule your brown bag appointment in advance
so the doctor or pharmacist plans enough time for
the visit. A good rule is to have a single doctor
“in charge” or aware of all the med ications and
products you take.
IN THE PHARMACY…
PROBLEM
PROBLEM
PROBLEM
Mistakes can sometimes happen when your
doctor orders a new medicine or when there
is a change in the dose of a drug you have
been taking. This may happen because some
drug names may sound-alike (when the
prescriber calls in the prescription) or lookalike (when the pharmacist reads handwrit ten prescriptions or picks the incorrect drug
from the shelf).
Dosing mistakes with liquid medicines
can happen if you do not use the measuring
device that came with the medicine or one
that is right for that medicine. If you use a
medicine cup from another medicine, it
may be a different size or have different
markings that could cause you to take the
wrong amount of medicine. When a
teaspoon is ordered it means 5 mL, but
since not all household teaspoons are the
same size you could be taking either too
much or too little.
Medication safety problems (such as getting
two prescriptions for the same drug and
taking two drugs together that cause a bad
side effect) can sometimes happen when
you use more than one pharmacy to
dispense your prescriptions. For example,
your family doctor may write a prescription
for Coumadin (brand name) to prevent
blood clots and your specialist may order
the drug by its generic name, warfarin. If
you fill them at different pharmacies, both
pharmacists would dispense the prescrip tion. Other problems occur when you have
prescriptions for two different medications
filled at two different pharmacies. For exam ple, your gynecologist gives you a prescrip tions for birth control pills and your primary care physician gives you a prescription
for antibiotics. In this case, neither pharmacist will be able to tell you that your birth
control pills may not work while you are
taking antibiotics.
RECOMMENDATION
When your doctor gives you a prescription
for a new medicine, ask him/her to write
the reason why you are taking the medicine
right on the prescription. This will help the
pharmacist give you the right medicine.
TIP
Even if you are busy or feel embarrassed, use the
pharmacy's confidential counseling service whenever
you pick up new prescriptions or there is a change
in your medications. When the clerk hands you
your medication, ask to speak with the pharmacist.
You need to make sure that the instructions on the
label are the same as your doctor wrote on the
prescription. Check the name of the medication,
the condition it treats, the dosing instructions (how
often you take it), and the number of times your
prescription may be refilled. If something doesn't
seem right, ask your pharmacist to telephone your
doctor. Never leave the pharmacy if you have
questions about your medications or are unsure
of how to take them.
7
RECOMMENDATION
When you take or give liquid medicines
only use the measuring device such as a
dropper that comes with the medicine.
If you get a liquid medicine from the
pharmacy and it does not come with a
measuring device, ask the pharmacist if
he/she can give you a special oral syringe or
tell you what device you should buy to
measure the medicine.
TIP
With many medicines, and especially for children
and older people, it is very important that the exact
dose of the medicine be given. Ask your pharmacist
to show you how to properly use the measuring
device for the dose and to what marking you should
fill the device. Make sure you understand before you
leave the pharmacy.
RECOMMENDATION
If you use more than one pharmacy to
get your prescriptions, you should pick a
primary pharmacy just like you choose a
primary doctor. The primary pharmacy
should keep an up-to-date personal
medication record for you. This should
include a complete list of all the medicines
you are taking, including o ver-the-counter
medications such as aspirin, herbals as well
as your current and past medical conditions.
The primary pharmacy should continually
review your profile to check for duplications
of therapy and drug interactions. If you
take a lot of drugs it is well worth paying
a pharmacist to look over all your medications for any problems in your care.
TIP
You should always know the brand and generic
names of your medicines. Ask your doctor to tell
you both names and make sure both drug names
(generic and brand) are clearly written on your
medicine container.
8
KEY QUESTIONS FOR YOUR
DOCTOR, PHARMACIST OR NURSE
ABOUT YOUR MEDICINES:
W
What are the brand and generic names of my medicines?
What does my medicine look like?
What am I taking my medicine for?
How much of my medicine should I take, and how often should I take it
(daily, twice a day, three times a day, etc.)?
What time of the day should I take this medicine (morning,
noon, evening, bedtime)?
Should I take my medicine with meals or on an empty stomach?
Do I need to avoid dairy products or fruit juices while taking
this medicine?
How long will I need to take this medicine?
If I start to feel better can I stop or take less of the medication?
What are the side effects of this medicine, and what should I do
if they happen?
What should I do if I miss a dose?
Does this medicine interact with my other medicines (herbals,
vitamins, etc.) or with food?
Does this medicine replace anything else I am taking?
Where and how do I store my medicine?
What should I do with any left over medicine?
TIP
Take these questions to your doctor and/or pharmacist. Write the answers down on a piece of
paper and make sure you understand all of the answers. Do not be afraid to ask them to repeat
any information that you do not fully understand.
9